Lung cancer : journal of the International Association for the Study of Lung Cancer
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Interventional bronchoscopy has evolved as an integral part of lung-cancer treatment but it is not always used to its full potential. The different methods can provide immediate relief of dyspnea and haemoptysis. Bleeding from central airway tumours can be stopped by coagulation preferably with the argon plasma coagulator. ⋯ Intramural tumour growth is most efficiently treated with high dose-rate endobronchial brachytherapy. Extrinsic compression or airway wall destruction require the placement of an airway stent. All methods can be combined and complement other palliation methods such as radiation or chemotherapy.
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Complete surgical resection remains the current standard of care for operable patients with stage-I or stage-II non-small-cell lung cancer. However, there is a strong rationale that supports the concept of the addition of systemic therapy to surgery either preoperatively or postoperatively even in patients with early-stage disease, as distant relapse continues to be the dominant form of relapse after surgical resection of NSCLC. ⋯ However, recently presented data of randomised phase-III trials showed an absolute survival benefit of 12-15% for patients with completely resected stage-IB and stage-II NSCLC receiving adjuvant platinum-based chemotherapy compared with observation alone. These trials provide resounding approval for adjuvant chemotherapy being the new standard of care for patients with early-stage non-small-cell lung cancer who have undergone complete resection of the tumour.
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Comparative Study
Prognostic significance of main bronchial lymph nodes involvement in non-small cell lung carcinoma: N1 or N2?
Accurate TNM staging is the basis to evaluate prognosis and to plan treatment of patients with non-small cell lung cancer. Exact definition of N status is fundamental and the boundary line between N1 and N2 stations is one of the most controversial issue. Purpose of this study is to evaluate the prognostic significance of main bronchus nodes, that we classified as station number 10 (N1). ⋯ The aim of a uniform anatomical and clinical classification of nodal stations has not been thoroughly achieved, particularly regarding the boundary line between N1 and N2. Our study points out that the involvement of main bronchial nodes has a prognostic significance similar to that of N2 single station and should be considered as an early N2 disease.
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Despite advances in therapy, the prognosis of lung cancer remains dismal due to the fact that most cases of lung cancer are diagnosed at advanced stages, when the chance of cure is poor. In cases detected at early stages prognosis is better. Unfortunately, early lung cancer usually causes no symptoms and is, consequently, rarely diagnosed. ⋯ The rate of invasive procedures for benign lesions was low; most indeterminate lesions could be classified with non-invasive diagnostic approaches. The proportion of interval cancers (cancers diagnosed by symptoms between two screening CT scans) was low. As, however, these one-arm feasibility trials are not appropriate to assess a potential mortality reduction through CT screening, prospective randomised multicenter trials were recently initiated in several countries to analyse the effect of CT screening on lung-cancer mortality.
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Percutaneous radiotherapy is an effective tool for the palliative treatment of patients with non-small-cell lung cancer (NSCLC). About two thirds of patients experience a notably improvement of symptoms after palliative radiotherapy. A whole variety of very different radiation schedules like a single fraction of 10 Gy, 2 fractions of 8.5 Gy, 10 fractions of 3 Gy, 25 fractions of 2 Gy, and others have been used for palliation. ⋯ Schedules like 2 x 8.5 Gy and 4 x 5 Gy are most appropriate in this situation. For patients with good performance status the choice of the optimal radiation schedule is less clear. Schedules with total doses between 30 and 45 Gy in 2.5-3.0 Gy fractions should be preferred in these situations.